HIV-Syphilis Coinfection

The Sexually Transmitted Infections Guidelines Committee of the New York State Department of Health AIDS Institute has recently released guidelines on the "Management of Syphilis in Patients with HIV." This guideline addresses transmission and prevention, screening, diagnosis, reporting and treatment, and posttreatment monitoring. The guideline aims to achieve the following goals:

Increase the number of people identified with HIV and syphilis coinfection and treat with effective interventions;
Reduce the case rate of primary and secondary syphilis by 10% and reduce disparities by specific populations that are disproportionally affected by syphilis infection[1,2];
Reduce the growing burden of morbidity and mortality associated with syphilis infection; and
Integrate current evidence-based clinical recommendations into the healthcare-related implementation strategies for the Ending the Epidemicinitiative, which seeks to end the AIDS epidemic in New York State by the end of 2020.

This guideline recommends at least annual syphilis screening for all patients with HIV. Screening for syphilis and other sexually transmitted infections (STIs) should be performed every 3 months for persons at high risk, regardless of the frequency of their HIVmonitoring visits.[1]

Cases of primary and secondary syphilis, the most infectious stages of the disease, have been increasing annually in the United States, especially in HIV-infected men who have sex with men (MSM).[3] In a Centers for Disease Control and Prevention analysis of 34 states, rates of primary and secondary syphilis were consistently higher among MSM who are diagnosed with HIV, compared with MSM who are not known to be HIV infected; however, the magnitude of the difference varied substantially across states.[4] Observed differences may be a result of increased incidence among HIV-positive MSM, as well as increased case detection through routine syphilis screeningamong MSM in HIV care.[5] The rate of reported primary and secondary syphilis cases in women increased by 36%, and the rate of congenital syphilis increased by 28% during 2015-2016.[3]

Get Comfortable Taking a Sexual History

Primary care providers and clinicians are often the first to see HIV-infected patients with STIs. Clinicians need to make taking a sexual history a priority and include it as a routine part of the history and physical examination.